Barts Cancer Institute, Queen Mary University of London, London, UK.
Department of Cellular Pathology, Barts National Health Service Trust, London, UK.
Lancet. 2024 Aug 3;404(10451):476-491. doi: 10.1016/S0140-6736(24)00917-6. Epub 2024 Jul 18.
The landscape of the management of renal cell carcinoma has evolved substantially in the last decade, leading to improved survival in localised and advanced disease. We review the epidemiology, pathology, and diagnosis of renal cell carcinoma and discuss the evidence for current management strategies from localised to metastatic disease. Developments in adjuvant therapies are discussed, including use of pembrolizumab-the first therapy to achieve overall survival benefit in the adjuvant setting. The treatment of advanced disease, including landmark trials that have established immune checkpoint inhibition as a standard of care, are also reviewed. We also discuss the current controversies that exist surrounding the management of metastatic renal cell carcinoma, including the use of risk assessment models for disease stratification and treatment selection for frontline therapy. Management of non-clear cell renal cell carcinoma subtypes is also reviewed. Future directions of research, including a discussion of ongoing clinical trials and the need for reliable biomarkers to guide treatment in kidney cancer, are also highlighted.
在过去的十年中，肾细胞癌的治疗格局发生了重大变化，导致局部和晚期疾病的生存率提高。我们回顾了肾细胞癌的流行病学、病理学和诊断，并讨论了从局部到转移性疾病的当前治疗策略的证据。讨论了辅助治疗的进展，包括 pembrolizumab 的应用——这是第一种在辅助治疗环境中实现总生存获益的疗法。还回顾了晚期疾病的治疗，包括确立免疫检查点抑制作为标准治疗的标志性试验。我们还讨论了目前围绕转移性肾细胞癌管理存在的争议，包括使用风险评估模型进行疾病分层和一线治疗的治疗选择。还回顾了非透明细胞肾细胞癌亚型的治疗。强调了未来的研究方向，包括讨论正在进行的临床试验以及对可靠生物标志物的需求，以指导肾癌的治疗。
